Provider Demographics
NPI:1902117104
Name:HOLTAN, MATTHEW JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:HOLTAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 111TH AVE N STE 5
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1835
Mailing Address - Country:US
Mailing Address - Phone:239-593-4915
Mailing Address - Fax:239-593-4914
Practice Address - Street 1:860 111TH AVE N STE 5
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1835
Practice Address - Country:US
Practice Address - Phone:239-593-4915
Practice Address - Fax:239-593-4914
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist